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Successful desensitization of a patient with albumin hypersensitivity.

So Yoon JUNG ; Yun Jung CHOI ; Seung Hyun LEE ; Hye Ryun KANG ; Dong In SUH

Allergy, Asthma & Respiratory Disease.2017;5(2):117-120. doi:10.4168/aard.2017.5.2.117

There have been few cases of albumin hypersensitivity reported, and there is limited information on this condition. When a patient is anaphylactic to a certain drug and no alternative drug is available to treat the underlying condition, desensitization is a reasonable option and can be performed successfully to treat the patient. A standard 12-step, 3-solution rapid desensitization protocol allows the safe readministration of a medication after certain types of immediate hypersensitivity. However, we demonstrated that a new 10-step, 1-solution desensitization protocol using antihistamine and leukotriene receptor antagonist as premedications, which was effective and safe in a patient with hypersensitivity. We report a 13-year-old boy with Gorham-stout syndrome who was presented with newly acquired albumin anaphylaxis and successfully treated with the 10-step rapid drug desensitization protocol.
Adolescent ; Anaphylaxis ; Desensitization, Immunologic ; Drug Hypersensitivity Syndrome ; Humans ; Hypersensitivity* ; Hypersensitivity, Immediate ; Male ; Premedication ; Receptors, Leukotriene

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DRESS (drug reaction with eosinophilia and systemic symptom) syndrome caused by both first-line and second-line antitubercular medications: A case report with a brief literature review.

Young Hoon HWANG ; Dong Yeon JANG ; Sung Yoon KANG ; Kyung Hee SOHN ; Dong Yoon KANG ; Chang Hoon LEE ; Hye Ryun KANG

Allergy, Asthma & Respiratory Disease.2017;5(2):111-116. doi:10.4168/aard.2017.5.2.111

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but potentially fatal drug-induced systemic hypersensitivity response characterized by erythematous eruption, fever, leukocytosis with eosinophilia, and internal organ involvement. Antitubercular agents are potential causative agents for DRESS syndrome but difficult to verify as a culprit drug, since antitubercular agents are coadministered as a combination regimen. A 42-year-old female with endobronchial tuberculosis was diagnosed with DRESS syndrome after 4-week treatment of isoniazid, rifampicin, ethambutol, and pyrazinamide with prednisolone 50 mg. All the antitubercular agents were stopped and replaced with levofloxacin, cycloserine, p-aminosalicylic acid, and kanamycin. However, severe exacerbation of DRESS syndrome compelled the patient to discontinue the administration of the second-line antitubercular agents. Two months later, the patient underwent a patch test for all the antitubercular agents which had been used, and the results showed positivity to isoniazid and cycloserine. We report a rare case of DRESS syndrome that reacted to cycloserine as well as isoniazid. Development of coreactivity to other drugs should be differentiated with a flare-up reaction in the management of DRESS syndrome.
Adult ; Aminosalicylic Acid ; Antitubercular Agents ; Cycloserine ; Drug Hypersensitivity Syndrome ; Eosinophilia* ; Ethambutol ; Female ; Fever ; Humans ; Hypersensitivity ; Isoniazid ; Kanamycin ; Leukocytosis ; Levofloxacin ; Patch Tests ; Prednisolone ; Pyrazinamide ; Rifampin ; Tuberculosis

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Risk factors for latent tuberculosis in children who had close contact to households with pulmonary tuberculosis.

Dong Hoon MIN ; Hwa Hyun WY ; Jae Won SHIM ; Duk Soo KIM ; Hye Lim JUNG ; Moon Soo PARK ; Jung Yeon SHIM

Allergy, Asthma & Respiratory Disease.2017;5(2):105-110. doi:10.4168/aard.2017.5.2.105

PURPOSE: Tuberculosis (TB) is a common and possibly fatal infectious disease, and its incidence and prevalence is quite high in Korea compared to other Organization for Economic Co-operation and Development countries. Patients who have active TB can cause latent tuberculosis infection (LTBI) in children, which may progress to reactivated tuberculosis. This study was performed to analyze the risk of adult TB that affects children's LTBI. METHODS: From June 2013 to May 2014, 60 children (32 boys, 28 girls) who came into close contact with adult patients diagnosed with pulmonary TB underwent LTBI tests. The children were divided into the 2 groups: the first group was finally diagnosed to LTBI, and the second group was proven not to have LTBI. We compared the risk of adult patients with pulmonary TB between children with LTBI and those without through a medical record review. RESULTS: The number of adult patients with TB was 36 (father 68%, mother 23%, grandparents 8%). The patients who came into close contact with the LTBI group were older (47.0±12.8 years vs. 41.3±6.6 years) and had higher erythrocyte sedimentation rate (ESR) levels than those of the second group. The rate of negative acid-fast-bacilli smear with positive culture results in patients who came into contact with the LBTI group was higher than in the second group. The cutoff value of ESR for the diagnosis of LTBI was 31 mm/hr with a sensitivity of 0.75 and a specificity of 0.85 (area under curve=0.748). CONCLUSION: Adult pulmonary TB patients who are older and have higher ESR levels may be risk factors for LTBI in children coming into close contact with them.
Adult ; Blood Sedimentation ; Child* ; Communicable Diseases ; Diagnosis ; Family Characteristics* ; Grandparents ; Humans ; Incidence ; Korea ; Latent Tuberculosis* ; Medical Records ; Mothers ; Prevalence ; Risk Factors* ; Sensitivity and Specificity ; Tuberculosis ; Tuberculosis, Pulmonary*

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Correlation between serum cytokines and clinical feature of children with mild lower respiratory infection.

Geon Ju KIM ; Yu Mi PARK ; Sul Mui WON ; Seung Jun CHOI ; Hwan Soo KIM ; Yoon Hong CHUN ; Jong Seo YOON ; Hyun Hee KIM ; Jin Tack KIM

Allergy, Asthma & Respiratory Disease.2017;5(2):99-104. doi:10.4168/aard.2017.5.2.99

PURPOSE: Acute lower respiratory infection (ALRI), which is frequently encountered in pediatric patients, is the leading cause of hospitalization. We aimed to identify particular cytokines that correlated with ALRI clinical characteristics. We also aimed to identify any differences in cytokines between respiratory syncytial virus (RSV)-related ALRI and non-RSV-related ALRI. METHODS: Cytokine levels were measured in the sera sampled from 103 pediatric patients diagnosed with ALRI and admitted to Seoul St. Mary's Hospital between May 2012 and April 2013. The correlations between cytokine levels and the length of hospitalization, the number of days with fever, body temperature, pulse rate, respiration rate, oxygen saturation upon admission, and duration of oxygen supplementation were analyzed. RESULTS: In children with ALRI, the level of interleukin (IL)-6, granulocyte-colony stimulating factor (G-CSF), and IL-10 were correlated with a higher body temperature on admission. In addition, the IL-8 level was correlated with pulse rate and respiration rate, and IL-1β level was related with oxygen saturation on admission. In children with RSV-related ALRI, the IL-6 was correlated the with duration of fever, and the IL-1β, IL-2, and IL-8 levels were related to pulse rate and respiration rate. In addition, the increase in interferon-gamma-inducible protein-10 (IP-10) level was correlated with a higher body temperature on admission and a longer duration of hospitalization in children with RSV-related ALRI. CONCLUSION: In children with ALRI, the levels of IL-6, IL-8, IL-1β, G-CSF, and IP-10 were correlated with its clinical features. In children with RSV-related ALRI, the IL-1β, IL-2, IL-6, IL-8, and IP-10 level was correlated with the severity of the disease.
Body Temperature ; Child* ; Cytokines* ; Fever ; Granulocyte Colony-Stimulating Factor ; Heart Rate ; Hospitalization ; Humans ; Interleukin-10 ; Interleukin-2 ; Interleukin-6 ; Interleukin-8 ; Interleukins ; Oxygen ; Respiratory Rate ; Respiratory Syncytial Viruses ; Seoul

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Clinical characteristics of lower respiratory infections in preterm children with bronchopulmonary dysplasia.

Na Hyun LEE ; Se Jin KIM ; Hee Joung CHOI

Allergy, Asthma & Respiratory Disease.2017;5(2):92-98. doi:10.4168/aard.2017.5.2.92

PURPOSE: We evaluated the clinical characteristics of lower respiratory infections of preterm children with bronchopulmonary dysplasia (BPD) and compared them between those with and without lower respiratory infections that of preterm patients without BPD. METHODS: This study enrolled preterm patients under 2 years old, who admitted with acute lower respiratory infection from March 2014 to May 2016. The patients were divided into 2 groups according to BPD, and we retrospectively reviewed their medical records. RESULTS: A total of 71 patients (106 cases) were enrolled; the BPD group consisited of 29 patients (54 cases) and the control group 42 patients (52 cases). Compared to the patients in the control group, those in the BPD group were older (P=0.001), had lower gestational age and birth weight (P<0.001), and showed more frequent readmission in hospital (P=0.017). The most common causative virus was human rhinovirus (hRV) in the BPD group, whereas respiratory syncytial virus (RSV) in the control group. The patients in the BPD group showed a higher incidence of tachypnea, decreased aeration, and chest retraction (P<0.001, P=0.009, and P=0.026, respectively), a higher respiratory symptom score (P=0.011), a longer duration of cough and wheezy sounds (P=0.004 and P=0.009, respectively), and higher incidence and longer duration of treatment with oxygen, and mechanical ventilator support (P=0.016 and P=0.017, respectively) than those in the control group. In the BPD group, the patients with RSV showed a higher incidence of tachypnea and rales (P=0.033 and P=0.033, respectively) than those with hRV. CONCLUSION: The preterm children with BPD may have more severe clinical manifestations than those without.
Birth Weight ; Bronchopulmonary Dysplasia* ; Child* ; Cough ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Medical Records ; Oxygen ; Respiratory Sounds ; Respiratory Syncytial Viruses ; Respiratory Tract Infections* ; Retrospective Studies ; Rhinovirus ; Tachypnea ; Thorax ; Ventilators, Mechanical

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Relationship between atopy and bronchial hyperresponsiveness to indirect stimuli in asthmatic children.

Tae Young PARK ; Min Ju YI ; Woo Hyeok CHOI ; Su Yeong KIM ; Rita YU ; Ji Eun BAN ; Seong YANG ; Il Tae HWANG ; Hey Sung BAEK

Allergy, Asthma & Respiratory Disease.2017;5(2):83-91. doi:10.4168/aard.2017.5.2.83

PURPOSE: Both atopy and bronchial hyperresponsiveness (BHR) are characteristic features of asthma. Several BHR studies comparing groups of atopic and nonatopic asthmatics have reported conflicting results. The aim of this study was to compare BHR to indirect stimuli, such as mannitol or exercise, between atopic and nonatopic asthmatics in children. METHODS: We performed a retrospective analysis of data from 110 children with asthma, aged 6–18 years using skin prick tests, and serum total and specific IgE levels. Atopy degree was measured using the sum of graded wheal size or the sum of the allergen-specific IgE. Bronchial provocation tests (BPTs) using methacholine were performed on all subjects. BPTs using indirect simuli, including exercise and mannitol, were also performed. RESULTS: Asthma cases were classified as atopic asthma (n=83) or nonatopic asthma (n=27) from skin prick or allergen-specific IgE test results. There was no significant difference in the prevalence of BHR to mannitol or exercise between atopic and nonatopic asthmatics. Atopic asthma had a significantly lower postexercise maximum decrease in % forced expiratory volume in 1 second (FEV1) (geometric mean [95% confidence interval]: 31.9 [22.9–40.9] vs. 14.0 [9.4–18.6], P=0.015) and a methacholine PC20 (provocative concentration of methacholine inducing a 20% fall in FEV1) than nonatopic asthmatics (geometric mean [95% confidence interval]: 1.24 [0.60–1.87] ng/mL vs. 4.97 [3.47–6.47]) ng/mL, P=0.001), whereas mannitol PD15 (cumulative provocative dose causing a 15% fall in FEV1) was not significantly different between the 2 groups. CONCLUSION: There was no significant difference in the prevalence of BHR to mannitol or exercise between atopic and nonatopic asthmatics in children.
Asthma ; Bronchial Provocation Tests ; Child* ; Forced Expiratory Volume ; Humans ; Immunoglobulin E ; Mannitol ; Methacholine Chloride ; Prevalence ; Retrospective Studies ; Skin

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The measurement of serum corticosteroid level in atopic dermatitis patients associated with application of topical corticosteroids.

Hyun Goo KANG ; Sun Ah LEE ; Hyun Jung KIM ; Hye Yung YUM

Allergy, Asthma & Respiratory Disease.2017;5(2):79-82. doi:10.4168/aard.2017.5.2.79

PURPOSE: Most of the atopic dermatitis (AD) patients and their parents refuse topical treatment because of concern about generalized side effect due to systemic absorption of topical corticosteroids. Therefore, a large number of studies reported difficulty in properly controlling in AD. However, investigations of the percutaneous absorption of topical corticosteroids are still insufficient. METHODS: One hundred nine patients who visited our atopy clinic and diagnosed as AD by a physician from January 2005 to January 2012 were enrolled. We examined serum corticosteroid (clobetasol propionate, hydrocortisone) level by liquid chromatography (LC) coupled with a tandem mass spectrometric (MS/MS) method. RESULTS: We developed the LC-MS/MS method to determine corticosteroids (clobetasol propionate, hydrocortisone) in sera of AD patients. Also, we confirmed precision, accuracy, limit of detection, limit of quantification, absolute recovery, and relative recovery of the experimental methods. We could not detect clobetasol propionate or hydrocortisone in sera of 109 AD patients using the newly developed LC-MS/MS method. CONCLUSION: Regardless of age, the severity and illness duration of AD, clobetasol and hydrocortisone were not detected in sera. Although there are many other factors of determining systemic absorption of topical medications, our results showed that topical corticosteroids applied for several years in AD patients may be under the limit of detection in their sera by the LC-MS/MS method.
Absorption, Physiological ; Adrenal Cortex Hormones* ; Chromatography, Liquid ; Clobetasol ; Dermatitis, Atopic* ; Diethylpropion ; Humans ; Hydrocortisone ; Limit of Detection ; Methods ; Parents ; Skin Absorption

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Serum periostin levels and squamous cell carcinoma-related antigen levels in children with atopic dermatitis.

Woo Hyeok CHOI ; Tae Young PARK ; Su Yeong KIM ; Rita YU ; Ji Eun BAN ; Seong YANG ; Il Tae HWANG ; Hey Sung BAEK

Allergy, Asthma & Respiratory Disease.2017;5(2):73-78. doi:10.4168/aard.2017.5.2.73

PURPOSE: It was found that periostin and squamous cell carcinoma-related antigens (SCCAs) were strongly interleukin-13-inducible gene products. This study measures the serum periostin and SCCA levels in children suffering from atopic dermatitis (AD) and to evaluate the association between the severity of AD and their values. METHODS: Seventy AD children aged 1 month to 10 years were included in our study. Subjects were characterized as having atopic eczema (AE; n=55) or non-AE (NAE; n=15) by atopic sensitization. Serum SCCA and periostin levels were measured. RESULTS: The serum periostin levels were significantly higher in children with AE than in those with NAE (geometric mean [95% confidence interval]: 80.47 ng/mL [75.06–85.93 ng/mL] vs. 67.45 ng/mL [59.99–75.64] ng/mL, P=0.020). The serum concentrations of both SCCA1 and SCCA2 were significantly higher in children with AE than in those with NAE (geometric mean [95% confidence interval]: 1.401 [1.198–1.643] ng/mL vs. 0.969 [0.723–1.268] ng/mL, P=0.039 for SCCA1) (1.178 [0.974–1.455] ng/mL vs. 0.711 [0.540–0.994] ng/mL, P=0.025 for SCCA2). The serum periostin levels were significantly correlated with disease severity and with peripheral blood eosinophil counts. The SCCA levels were not significantly correlated with disease severity. Both SCCA1 and SCCA2 were significantly correlated with serum periostin levels and blood eosinophil counts. CONCLUSION: Serum periostin levels may be significantly correlated with disease severity and blood eosinophil counts in children with AD. Serum SCCA levels can be significantly correlated with serum periostin levels and blood eosinophil counts in children with AD.
Child* ; Dermatitis, Atopic* ; Eosinophils ; Epithelial Cells* ; Humans

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Development and properties of hypoallergenic infant formula.

Woel Kyu HA ; Jeongmin LEE ; Kyu Earn KIM

Allergy, Asthma & Respiratory Disease.2017;5(2):63-72. doi:10.4168/aard.2017.5.2.63

Milk proteins are composed of casein, further classified into αS1-casein, αS2-casein, β-casein, and κ-casein, and whey protein, which is separated into α-lacatalbumin, β-lactoglobulin, serum albumin, and some minor proteins, such as lactoferrin and immunoglobulin. To reduce the allergenicity of protein, heat treatment and enzymatic protein hydrolysis by endopeptidase are necessarily required. Additionally, membrane technology should be applied to produce a protein hydrolyzate, which has consistent molecular weight of peptide and low in free amino acid without allergenic peptide or protein. Extensive casein hydrolyzate and whey protein hydrolyzate are used for protein source of mainly extensively hydrolyzed protein formula (eHF) intended for the treatment of cow's milk allergy. Also, partially hydrolyzed formula (pHF) is developed, which is using a single protein source e.g., whey protein hydrolyzate. The allergenicity of infant formula can be determined according to molecular weight profile and antigenicity reduction compared to intact protein. More than 90% peptides are present in eHF have a molecular weight of <3,000 Da. Peptide molecular weight profiles of pHF range mainly between 3,000 and 10,000 Da, but have a small percentage of >10,000 Da. Generally, antigenicity reduction in eHF and pHF is 10-6 and 10-3, respectively. Even if protein hydrolyzate is manufactured under strict quality control, there is still a risk of cross contamination of allergenic milk components through environmental conditions and the shared manufacturing process. Thus, quality assessment of protein hydrolyzate formula must be performed routinely.
Caseins ; Hot Temperature ; Humans ; Hydrolysis ; Immunoglobulins ; Infant Formula* ; Infant* ; Lactoferrin ; Membranes ; Milk ; Milk Hypersensitivity ; Milk Proteins ; Molecular Weight ; Peptides ; Quality Control ; Serum Albumin ; Whey Proteins

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New biomarkers in atopic dermatitis.

Jihyun KIM

Allergy, Asthma & Respiratory Disease.2017;5(2):61-62. doi:10.4168/aard.2017.5.2.61

No abstract available.
Biomarkers* ; Dermatitis, Atopic*

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